Integrated analysis of protein and glucose metabolism during surgery: effects of anesthesia

Abstract

The aim of this study was to assess dynamic changes in protein and glucose metabolism during surgery. Twelve patients undergoing colorectal surgery received either intravenous propofol anesthesia (n = 6) or inhalational anesthesia with desflurane (n = 6). Pre- and intraoperative protein and glucose kinetics were analyzed by an isotope dilution technique using L-[1-(13)C]leucine and [6,6-(2)H(2)]glucose. Plasma concentrations of glucose, lactate, free fatty acids, insulin, glucagon, and cortisol were measured before and after 2 h of surgery. The rates of appearance of leucine and glucose, leucine oxidation, protein synthesis, and glucose clearance decreased during surgery, independent of the type of anesthesia (P < 0.05). A correlation between the rate of appearance of leucine and glucose was observed (r = 0.755, P < 0.001). Intraoperative plasma cortisol and glucose concentrations increased (P < 0.05), whereas plasma concentrations of lactate, free fatty acids, insulin, and glucagon did not change. Surgery causes a depression of whole body protein and glucose metabolism, independent of the anesthetic technique. There is a correlation between perioperative glucose production and protein breakdown.

Randomized clinical trial of the effect of preoperative oral carbohydrate treatment on postoperative whole-body protein and glucose kinetics

“…A correlation between EGR and whole-body protein breakdown before, during and after surgery has been reported 14,33 . In the present study an association was found between the same parameters during insulin stimulation after surgery.…”

“…Whole-body protein synthesis and breakdown have been reported to be decreased within 2 h of colorectal surgery 14 but are found to be increased after 2 days 15 . However, they are unaltered 1 day after hip replacement 16 .…”

Effect of acute hyperglycaemia and diabetes mellitus with and without short-term insulin treatment on myocardial ischaemic late preconditioning in the rabbit heart in vivo

“…In non-diabetic animals, the relatively high blood glucose concentrations during baseline conditions after surgical preparation can be explained easily by the surgical stress which increases blood glucose concentrations by reducing utilization [24] and probably also by increasing gluconeogenesis [17]. Despite this moderately increased blood glucose concentration, the marked protective effect of LPC was still apparent.…”

Effect of Glucose Administration on the Metabolism during Surgery

“…Depression of whole body protein and glucose metabolism are caused by surgery, independently of the anesthetic technique [27]. The emotional stress of being brought to the operating theatre and the stress of surgery seem to be more important than anesthesia in causing a rise in blood sugar and plasma FFA [28].…”